Amanda Lynn Bolotta

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

400 Stoddard Rd
Richmond, MI 48062-2505

Phone

(810) 392-2167

NPI assigned

Oct 7, 2019

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 27, 2023.

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1609417146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 MCPHERSON ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603239",
            "telephone_number": "810-941-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 STODDARD RD",
            "city": "RICHMOND",
            "state": "MI",
            "postal_code": "480622505",
            "telephone_number": "810-392-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLOTTA",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-07",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amandabolotta@sacredheartcenter.com",
            "affiliation": "Y",
            "affiliationName": "Sacred Heart Rehabilitation Center, Inc.",
            "address_1": "400 Stoddard Rd",
            "city": "Richmond",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480622505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Richmond, MI
• Peer Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.